In an attempt to find out the effect of epidural administration with morphine on postoperative pain relief, a small dose of morphine with a local anesthetic(lidocaine) was administered into the epidural space, either by lumbar or caudal approach. Morphine injected into the epidural space has been suggested to produce it's effect by direct action on the specific oplate receptor in the substantia gelatinosa of the posterior horn of the spinal cord. 90 patients who were anesthetized under epidural block in the Pusan Paik's Hospital, INJE Medical College, from May 1980 trhough Jan. 1981 were divided into the groups "Lidocaine alone" and "Lidocaine + Morphine". The number of patients of patients of the lumbar approach was 73 (81.1%) and of the caudal approach was 17(18.9%). The group "Lidocaine alone" numbered 45 cases which were injected with 2% lidocaine into the epidural space as an anesthetic. Group "Lidocaine + Morphine" also numbered 45 cases and received 2mg of morphine with 500 mg of 2% lidocaine as an epidural anesthetic. 0.2mg of 0.1% epinephrine was mixed to the anesthetic solution in all the above cases. The results of this study are as follows: 1) Alteration of arterial blood pressure during anesthesia was minimal within 30 minutes after injection of the epidural anesthetic in both groups. 2) Duration of postoperative pain relief in the group "Lidocaine + Morphine" was significantly extended comparing it to that in the group "Lidocaine alone". 3) Between the two groups, no significant difference was noted in recovery of spontaneous volding. 4) Complications were similar in both groups except for nausea and vomiting which occurred more frequently in the group "Lidocaine + Morphine"(8.9% and 6.7%, respectively) than in the group "Lidocaine alone" (2.2% and none, respectively). Any signs of CNS depression or neurologic sequelae were not observed.
Anesthesia ; Anesthesia, Epidural* ; Animals ; Arterial Pressure ; Busan ; Depression ; Epidural Space ; Epinephrine ; Horns ; Humans ; Lidocaine ; Morphine* ; Nausea ; Pain, Postoperative* ; Spinal Cord ; Substantia Gelatinosa ; Vomiting

It has been emphasized that continuous monitorings of arterial pressure, central venous pressure, electrocardiogram, blood gas analysis, serum electrolytes, body temperature, hematacrit and urinary output are mandatory for the anesthetic management of pheochromocytoma. In addition, it is necessary for the anesthetists to understand pharmacologic effects of drugs which influence the peripheral vascular tone and cardiac excitability. We experienced recently anesthetic management of two cases of pheochromocytoma; one raised problems of ventricular arrhythmias and hypertension that aggravated nature of arrhythrmias by increasing blood pressure and responded favorably to treatment with propranolol and trimetaphan. Tumor of this case originated from abdominal aortic wall. The other was managed by injection of d-tubocurarine which induced narrowing of pulse pressure by depletion of increasing systolic pressure and accompanied tachycardia without cardiac decompensation. We have reported proper anesthetic managements of two cases of pheochromocytoma with N2O O2-halothane anesthesia and reviewed literatures in discussion.
Anesthesia ; Arrhythmias, Cardiac ; Arterial Pressure ; Blood Gas Analysis ; Blood Pressure ; Body Temperature ; Central Venous Pressure ; Electrocardiography ; Electrolytes ; Hypertension ; Pheochromocytoma* ; Propranolol ; Tachycardia ; Trimethaphan ; Tubocurarine

To determine the effects of hydrcxyethyl starch upon liver, kidney, serm electrolytes and particularly upon blood coagulation, 500 ml of 6% HES in saline solution was administered intravenously to 15 patients during elective minor surgery. In all cases weighted blood loss was less than 600 ml without replacement. The following laboratory tests were performed immediately before infusion and again 1 hour, 24 hours, 48 hours, and 1 week after the infusion: RBC, WBC, hemoglobin, hematocrit, ESR, platelet, bleeding time, coagulation time, prothrombin time, total protein, albumin, total bilirubin, direct bilirubin, SGOT, SGPT, alkaline phosphatase, BUN, sodium, potassium, and chloride. The results are as follows: 1) No anaphylactic shock or bleeding tendency characteristic of colloids was encountered. 2) No functional disturbance of liver or kidney directly attributable to HES was identified. 3) All laboratory parameters except WBC and ESR decreased after infusion. The decrease was, however, within the normal range and believed secondary to dilational effect of infusion. WBC increased somewhat, but returned to the preinfusion level in a week. 4) Exceptionally erythrocyte sedimentation rate increased notably during the 24 hour period following infusion. As with dextran, this was interpreted not due to direct effect of HES, but due to increased adsorption of fibrinogen, alpha-beta-gamma-glcbulin to red cell surface with changes in electric charge between red cells. 5) Clinical applicability, metabolic aspect, degree of subtitution of hydroxyethyl group and safety with multiple infusion of HES must be carefully determined.
Adsorption ; Alanine Transaminase ; Alkaline Phosphatase ; Anaphylaxis ; Aspartate Aminotransferases ; Bilirubin ; Bleeding Time ; Blood Coagulation ; Blood Platelets ; Blood Sedimentation ; Colloids ; Dextrans ; Electrolytes ; Fibrinogen ; Hematocrit ; Hemorrhage ; Humans ; Kidney ; Liver ; Potassium ; Prothrombin Time ; Reference Values ; Selective Estrogen Receptor Modulators ; Sodium ; Sodium Chloride ; Starch* ; Surgical Procedures, Minor

We had experienced anesthetic management of two patients with bilateral pheochromocytoma. They had been treated with phenoxybenzamine for 4 weeks preoperatively. Anesthesia was managed with thiopental sodium for induction,enflurane-N2O-O2 for maintenance, vecuronium for muscle relaxation, and sodium nitroprusside for controlling severe hypertension. After tumor resection, severe hypotension was controlled by rapid transfusion, fluid and dopamine infusion. A tolerable blood pressure and pulse rate were maintained throughout the procedure. Preoperative preparation, sufficient sedation, smooth anesthetic induction, complete analgesia, good muscle relaxation, adequate ventilation and proper cardiovascular control are required in resection of pheochromocytoma.
Analgesia ; Anesthesia ; Blood Pressure ; Dopamine ; Heart Rate ; Humans ; Hypertension ; Hypotension ; Muscle Relaxation ; Nitroprusside ; Phenoxybenzamine ; Pheochromocytoma* ; Thiopental ; Vecuronium Bromide ; Ventilation

A patient who had been admitted to the B.N.U.H. with coma and respiratory arrest from possible acute alcohol intoxication, has been treated with intensive care and discharged without any complication. It should be emphasized that a patient with respiratory arrest even due to unknown etiology must have continued intensive care, without giving up the patient.
Coma ; Humans ; Critical Care ; Resuscitation*

A patient who had been admitted to the B.N.U.H. with coma and respiratory arrest from possible acute alcohol intoxication, has been treated with intensive care and discharged without any complication. It should be emphasized that a patient with respiratory arrest even due to unknown etiology must have continued intensive care, without giving up the patient.
Coma ; Humans ; Critical Care ; Resuscitation*

An anesthesiologist must have full control of the patient's airway at all time. But he may occationally find himself in a very challenging and dangerous situation, where control of the airway is in question. The present case report describes parioperative management of newborn pharyngeal teratoms, including cafeful perioperative ovaluation of the upper airway and provision for a secure periope rative airway.
Humans ; Infant, Newborn* ; Teratoma*

The authors have experienced five cases of general anesthesia for repair of diaphragmatic hernia in children, and following results were obtained. Whether it was congenital or traumatic in origin, prompt reduction and repair is desirable if accurate diagnosis was made and patients condition was acceptable, for increased postoperative survival rate and prevention of possible complications. When the intermittent positive pressure breathing was needed during preoperative, intraoperative or postoperative period, the greatest concern of anesthetist is that excessive positive ventilation should be avoid. The most important factors in this situation probably are the use of chest drainage, daily Roentgen-ray examination, and better use of postoperative ventilatory assistance, for prevention of postoperative atelectasis and other pulmonary complications.
Anesthesia, General* ; Child* ; Diagnosis ; Drainage ; Hernia, Diaphragmatic* ; Humans ; Intermittent Positive-Pressure Breathing ; Postoperative Period ; Pulmonary Atelectasis ; Survival Rate ; Thorax ; Ventilation

The authors have experienced two cases of general anesthesia for operation of congenital tracheo-esophageal fistula and the results were obtained as follows. 1. The anesthetic agent should be selected as considering of lesser irritating to respiratory system and smaller amount of tracheobronchial secretion. 2. The infant circle absorber system has been preferred to the Ayres T-piece apparatus, because maintaining normal body temperature and removal of carbon dioxide easily. 3. Removal of secretion from trreheobronchial tree, intermittent positive pressure breathing, maintaining normal body temperature and humidity were thought to be necessary for the prevention and treatment of postogerative pneumonia or atelectasis.
Anesthesia, General* ; Body Temperature ; Carbon Dioxide ; Esophageal Atresia* ; Fistula* ; Humans ; Humidity ; Infant ; Intermittent Positive-Pressure Breathing ; Pneumonia ; Pulmonary Atelectasis ; Respiratory System

A 22 year-old-male-patient of Pyoderma Gangrenosum had been suffered from longstanding ulcers at his cheeks, nuchal region and upper back, which had been treated with corticosteroids and antibiotics without any effect. We have applied 49 times of hyperbaric oxygen therapy to the patient at 2.0~3.0 atmospheres absolute pressure. The pressure was increased for 15 min, then kept constant at the desired presseure for 30 min., and reduced to the atmospheric pressure within 5 min. The ulcer. had been treated with hyperbaric oxygen and revascularization was noted in the scars.
Adrenal Cortex Hormones ; Anti-Bacterial Agents ; Atmosphere ; Atmospheric Pressure ; Cheek ; Cicatrix ; Humans ; Hyperbaric Oxygenation* ; Oxygen ; Pyoderma Gangrenosum* ; Pyoderma* ; Ulcer